But in regards to government-funded health care — including Medicare and Medicaid — Dr. Berwick is right, so it does no good to shoot the messenger.

Medicare, Medicaid, and all collectivized medical care require rationing for the simple reason that all scarce resources must be rationed.

When you and I live within our means, we’re rationing. Although we usually think of it as budgeting, what we do is figure out how much money we have to work with, set our priorities, and then ration our resources accordingly. Some for food and housing. Some for medical care. Some for our kid’s education and future. We each have different sets of priorities and values, so our spending is highly individualized and personal. We get to do this, because we own those resources. Because what we would like to spend far exceeds what we can spend (as limited by our personal financial reserves) we must privately ration.*

The need to ration doesn’t change simply by pooling resources. In fact, pooling resources into common ownership makes planning all the more difficult. When medical resources are collectivized, we turn the industry which cares for us when we are injured, ill, or dying into a Tragedy of the Commons. Instead of Hardin’s example of cattle overgrazing the land, our infinite demand for health care leads to rising prices and a soaring national debt — unless we ration.

Without rationing, we will run up trillions of dollars of debt and drive the country towards bankruptcy. Oh, wait. We’re already doing that … and without rationing, it’s going to get much worse.

In a free society, individuals make their own rationing decisions according to personal priorities and privately owned resources. If a neighbor’s help is needed, it must be asked for and then given voluntarily. When resources are collectivized (or nationalized, or socialized, it’s all the same thing) a central decision making body must do the rationing. Individual personal priorities are subordinated to the priorities of the group — which in practice ends up being a small group of the politically powerful.

39 Comments, 26 Threads

1.
eon

Before Medicare, etc., the best advice for poor people regarding health care was “don’t get sick, or old.”

Today, the same axiom applies with Medicare, etc.

ObamaCare seeks to “level the field” between the poor and everybody else, by ensuring that everyone has equally inadequate health care, run by bureaucrats and politicians with a seemingly boundless appetite for power over the rest of us. And who will carefully insulate themselves from the very “health care” system they create for the rest of us. (Waivers, anyone?)

I do not believe Dr. Berwick should be “shot for being the messenger”. I do believe that, as one of the architects of a socialistic, impractical, and potentially disastrously totalitarian system, he will be damned in the eyes of future historians as a narcissistic, egotistical fool on a par with The One Himself. And I do not expect Him to be treated kindly in a century, even by true-believing PoliSci types.

I expect the pair of them to be treated even less kindly in a decade, when the train wreck they are creating for the American people becomes obvious to the electorate.

Reality hits them all, sooner or later. And sending the message back marked “Not Acceptable!” doesn’t work forever.

Vote with our feet? Either we move to a country where they don’t yet have socialized medicine – perhaps Chile – or we peacefully but indomitably occupy Washington DC and refuse to allow anybody to enter or leave the Capitol until Obozocare is repealed, and we refuse to allow Zero to disembark from Air Force One until he signs the repeal. It may take a million of us to get it done, but it’ll be worth it.

Only when our government fears the citizenry, rather than the other way around, will we become a free people once again.

“Medicare, Medicaid, and all collectivized medical care require rationing for the simple reason that all scarce resources must be rationed.”

Yes, but the problem starts when you are younger or are a little wealthier and are paying (yes PAYING) for your own insurance policy. If the Healthcare Industry is taken over by the government (as will be the case under Obamacare) then rationing will take place even for people NOT on Medicare or Medicaid. Under our own current policies, we pay for medical services that we want, NOT what the government wants or thinks it can afford. But under Obamacare you would be taking this choice away from us and substituting it for a much worse set of government healthcare regulations which we do not want.

Sorry, but if I am in my fifties and have my own private insurance and I have a heart attack, then my healthcare provider gets stuck with the bill. I pay HUGE insurance premiums now for just such an emergency and expect my insurance company to pick up the tab if I get sick. That’s why they call it INSURANCE. But if the Government takes over the Healthcare industry, the federal government could limit the amount of services I get in order to pay for those people on Medicare or Medicaid. Quite frankly, I don’t really care about them because I am PAYING for coverage for me and my family, NOT the people on Medicare of Medicaid. Unless we reach a point where we have total socialized medicine, where everybody gets the same crappy health care like in Europe, then why should I have to pay to make up the difference for the other poorly-run government programs?

Either you socialize the whole thing (which is what Obama, Pelosi, and Reid wanted to do), or you reform the system we now have. But to force more government regulations on people who are PAYING for their own health insurance is criminal.

Liberty, you are already paying for people on Medicare. That’s partly why insurance premiums are so high. What the feds pay the insurance companies for Medicare is way below the going rate of medical costs. Who picks up the rest? The insurance carriers. They pass that cost on to their customers.

OBamaCare is collectivized health care—it’s just being done primarily through control of the insurance companies instead through control of the individual doctor and patient…only more and more control is occurring there as well.

I don’t see that we are in disagreement. I am just tired of the politicians who rail against ObamaCare but scream bloody murder when someone talks about rationing in Medicare.

Anyone who thinks the National Health Service in the UK is a good model for providing healthcare is obviously delusional and brain dead. That would be sufficient to villify him or anyone else with these views.

This article knocks down a straw man, abuses the English language, and then closes with an Emily Litella-like “Never mind!”

First, the hostility toward Dr. Berwick is not because he recognizes the obvious implication that collectivizing requires rationing. It’s because he is in love with collectivizing health care in the first place. There is no insight here.

Second, the article says: “When you and I live within our means, we’re rationing. Although we usually think of it as budgeting, what we do is figure out how much money we have to work with, set our priorities, and then ration our resources accordingly.” This suggests that free market economies “ration.” But any reasonable definition of “rationing” must exclude the free market, or else the word loses its meaning. The free market allows you to purchase as much of a good as you choose, at a price. Choosing to live within a budget is not “rationing.”

And it seems that a belated recognition of this results in a big “Never mind!” at the end (“This is not to imply that markets or prices ration.”) Maybe it would have been better for the writer to have gone back and rewritten the article. Or just abandon it.

Thank you, Dr. Haynes for this piece. The real problem is not Berwick per se — he’s just a symptom of the much bigger problem of statism and the wrong-headed belief that the government can and should guarantee health care as some sort of “right”.

(I also appreciated your clarifaction at the end on the nature of free markets vs. rationing.)

I read that Dr. Berwick was praising Britain’s national “healthcare” system, even as that system was (is) in the process of melting down.

I don’t want an ideologue anywhere near the “practice” of medicine.

Rationing? How about applying common sense relative to radical and expensive treatments towards the end of life. Common sense (not so much in vogue anymore) used to dictate any given individual’s course of medical treatment.

Now we have a President who talks about physicians lopping off limbs and yanking out tonsils for profit or who tells a woman that her aging mother shouldn’t get a pacemaker but just take a pain pill (!) for her arrhythmia. Or an advisor to said President (Dr. Zeke Emanuel) developing a Quality Adjusted Life Years index where your doctor has to call up some bureaucrat and find out what course of treatment he can offer you as a function of your age and stage.

Yipes !

I have watched the medical system go down into a bureaucratic ring of fire as “government” has become more enmeshed in my lifetime.

Dr. Berwick seems too comfortable with the infusion of bureaucracy into medicine.

I wish the radical leftists who now control aspects of our lives as little czars and czarinas would simply come out in the open and adopt the Bill Ayers methodology and cut out the middle man.

It’s not health care they want to ration, it’s quickening the pace of attrition of those stubborn older voters. Ayers simply wasn’t thinking big enough when he suggested wiping out 25 million of them.

To ensure that another “shellacking” doesn’t take place and that the permanent encampment of radical leftism is cemented, one has to think both short term and long term. Berwick is quite capable of both.

We already have a rationing mechanism that is so good that standards of living have improved by orders of magnitude in a few hundred years…as opposed to the stagnant standards that had been in effect for thousands of years under the mechanism of central planning, as implemented by pharoes, kings, commisars, and dictators.

It’s called free markets.

Somehow, Dr. Berwick and any amount of other geniuses you want to pick aren’t going to be able to come close to free markets, any moreso for elder care than for agricultural products.

If these idiots would GET OUT OF THE FRIGGING WAY, within a few decades life spans will increase by decades and senior citizens will become assets to the world, instead of the sinkholes these criminals want you to beleive that seniors (read: YOU in a few years) are.

No doubt this Party neocomradess thinks of herself as possessin’ an especially clear an’ steel-claptrapped sort of mind, unafraid — save for some pretty silly quibblin’ at the end — to admit that everybooby who does medicine at all does death panels. Unafraid, more remarkably, even to warn the sweet puppies of Redarkenment away from silly sentimentalism an’ idle whimperin’ an’ selfswoonin’.

However, ¿isn’t she really a wishy-washy half-an’-halfer? Or to put the same point in pecuniary rather than ideological terms, ¿Isn’t it likely that the Freedame of Haynes does not in fact meet the minimum standards for bein’ a TopPercenter? ¿That her freeladyship is here defendin’ the interests of a Class to which she does not, in fact, belong? ¿To which she cannot afford to belong?

I have no idea, naturally, having never heard of this particular freeladyship before this morning, but it seems a bit unlikely. Certainly, there cannot be a large number of freelords an’ freeladies who do. The Witch Doctor of Democracy himself, as it happens, informed his dittobrains perhaps a year ago that he is sittin’ in the Crassus seat, but ¿Is he really? ¿Can we have gone into such decline already that the financial entrepreneurship of our Divine Homeland™’s medical community cannot come up with therapies so expensive that even Citizen Rush would be compelled to do without?

Prescinding from an impertinent pocketbook inquisition, consider the precise quality of her freeladyship’s steel claptrap, especially in the passage where she barks

The only way to escape the need for centralized rationing is to recognize that health care expenditures are not a national phenomenon, but an individual one. We have to stop thinking of medical care in collectivist terms, such as a ‘national resource’ available for dispersal through political wrangling. Medical care is of, for, and by private individuals. The proper alternative to the increasingly top-down, coercive central planning integral to our current system is restoring to each of us the right and responsibility for making our own rationing decisions.

I fear there is no genuine steel here at all, only some agitprop aluminum foil an’ rhetorical rubber bands. In fact, her freeladyship strikes me as positively beggin’ for a strictly _ad feminam_ response. The Freedame of Haynes stamps her shapely (?) hoof an’ demands that ‘we’ RECOGNIZE this an’ STOP THINKIN’ that an’ confine ‘ourselves’ to PROPER ALTERNATIVES only. We are not troubled with any confusing reasons on account of which we should comply with the proposed regulations. Indeed, Dr. Bones, the little freelady might as well just simper at us an’ ad-fem it frankly: “¡Kindly allow me to know best!”

Though in a certain fashion unanswerable and inexpugnable, that ploy is thoroughly unimpressive, steelclaptrapwise. The only thing I can thing of off-hand that might render it less than laughable would be if G*re’s green earth were full of other countries where the proposed régime is actually in force. As far as I know, however, there are none. Such LBW, Lesser Breeds Without, as do not have a public medical system because they more or less don’t have any medicine worthy of mention do not seem to me to be voting with her freeladyship.

Possibly, though, ¿the Freedame of Haynes seriously wishes to redecorate the _Heimatland Gottes_ in the likeness of Namibia or Papua-New Guinea?

Well, if so, I take back any faint praise of her neo-intrepidity that may have escaped me above. ¡Let her freeladyship tell the selfservative kiddies of that bold neovision unmistakeably! — an’ then maybe we can talk. Or maybe not, considering that her freeladyship will then have positioned herself beyond talkin’ to even by them feverswamp dwellers down southeast of Hooverville.

Meanwhile, the specter that haunts the freelordly an’ kiddiemagisterial discourse is as plain as the bubble gum on your subway seat: somehow or ’nother, la Haynes must get ’round the plain fact that her Uncle Sam could — and many LBW actually do — manage to own and operate Mayo Clinics collectively that perhaps scarcely any individual (zoölogical, noncorporate) citizen could finance alone.

Her freeladyship must get ’round it — yet she declines even to try.

A curious style of agitprop is the Haynesian: just tell the kiddies that they simply must not think of a foxcuckoo’s tale when they walk around the graveyard three times — AN’ THEN THEY WON’T.

Great stuff if it works, I daresay, but I cannot make out how it ever possibly COULD work, unless maybe her freeladyship slips somethin’ neoïnnovative from her funder friends at Big Pharma into the water supply on the side. But, sir, ¿don’t you think we would have heard rumors by now if the G.O.P. Geniuses had come up with so thrillin’ a neoproduct as that? “Better polemic for Party an’ AEIdeology through chemistry” is an appealing idea, sort of, but not actually in the works. (¿Is it?)

In the absence of Murti-Bing pills [0] or the equivalent, her freeladyship’s tactic must, I think, be evaluated as above: she says she would like us to believe that only the individual or noncorporate citizen can properly have anythin’ to do with public medicine. She does not choose to explain how and why this should the case.

It would be rude, and indeed ’rong, of us to doubt the subjective sincerity of the Freedame of Haynes, and of her funder friends even more so — “all animals are serious at feeding time.” She, an’ they, really would like us to think just exactly that.

Now I am as willing to be psivil even with wingnutettes an’ wingnuts — up to a point, but to extend our psivility to acceptin’ what they bark as whight an’ leap to obey simply because they bark it is a maxim that applies only very narrowly. [1]

“¡Kindly just allow us kiddie selfservatives to know best!” is rather too much to ask.

More exactly, though nothin’ be too much for immoderate extremism to ask in the path of Party and Ideology, yet let us political grown-ups resolve never to be such damfools as to dream of granting this petitioner’s self-servicin’ prayers. Or anybooby else’s prayers similarly framed. “¿How dumb do they think we are?”

[1] You might, for example, remove your bubblegum wad from the adjacent bus seat SIMPLY BECAUSE some firstlord or freedame (even possibly an average wurtzelbacher) has announced that she would like to replace it in residence there. Beyond that sort of comparative triviality, however, a firm line must be drawn against the _sit pro ratione voluntas_ shtyk .

Should you run into the Freedame of Haynes yourself, sir, advise her, temperately but firmly, that bein’ madashell an’ not gonnatakeitanymore will not get her freeladyship that cup of coffee until the $1.69 surcharge has been tendered.

I never knew what exactly the word “pretentious” meant until today. You, sir, are a good example. You are coming off more like an ass than the intellectual you want all to worship. Your composition style is long, tedious confusing with invented words. Sorry, I’m not impressed. And your use of apostrophes is so cute. So very down-to-earth humorous.

So Beth, we can at least agree — the definitive need for rationing is not inherent in all healthcare financing and access schemes ?

And if I want to vilify Berwick for overseeing implementation of this financially suicidal monstrosity it is perfectly logical. He is choosing to enable it — and I’d bet you a sphygmomanometer there’s no place he’d rather be.

Yes. There definitely is a system where people get to make their own health care decisions using only the resources they own, or can voluntarily obtain from others. It’s called capitalism.

We can debate on whether or not using term “rationing” to apply to individual, free choices or should only apply to coercive acts. I keep going back and forth on that. If I am in a life boat with only so much water and food, I will “ration” it our to make it last longer.
The danger is that people will think that the market or prices ration–which is a bit like saying guns murder.

And as for Berwick– he is a man of the times: Keynsian in his economics and Rawlsian in his ethics. But, get rid of him, and you will get his clone. It’s his ideas which need to be attacked, not him.
And for goodness sake, when he says we have to ration Medicare –he’s right.

Collectivism never worked and never will. Specially forced collectivism of
the 20th century. We have witnessed over and over again how collectivism collapsed like house of cards unless it is enforced by brutal tyrants.
Obamacare is one of those force collectivism which contradicts natural forces of individual survival or more precisely life itself. Since
Life by definition is selfish no individual will give up life voluntarily.

I am a physician, and can speak for the majority of physicians in this country. Berwick is an idiot. That is not remotely in dispute in the medical community. Yes, rationing is necessary and inevitable. But, physicians KNOW that the government hacks shouldn’t be the ones making the decisions.

Put it in the hands of DOCTORS and we can make it work. We know where precious resources can and should be most effectively utilized. Bureaucrats do not.

Well, both Dr. Berwick and Dr. Haynes are arguing from a basic flawed assumption and that is that health care is a commodity that is subject to market forces. It is not because health care is controlled and delivered by the MD monopoly. MDs know where there bread is buttered and it sure ain’t the free market. If there was a free market, medical schools would not be regulated to limit access, foreign residents wouldn’t have such a miserable time trying to get certified, and there would be a booming business for allied professionals like nurse practitioners.

Look, I’m not arguing that medicine should be completely unregulated. An MDs wil always be a valuable part of the health care mix. But monopolies always lead to higher prices and limited choice. Break the MD monopoly and a real health care market with innovative solutions can flourish.

The government-sanctioned cartel created by physician licensing is definitely part of the problem–but it’s just one of many. The largest battle we must win is that against considering health care to be a “right”–which underlies much of the justification for government control and interference in what would best be handled privately.

As a physician you would say that. And hey, go for it if you can. But you are part of the problem, and a bigger part than you would care to admit. Gov’t involvement in health care is distorting. But I would argue that given the monopoly on health care delivery that exists, at least gov’t as a very large purchaser of health services can mitigate some of the power that the medical community wields. It’s a lousy system but it won’t be fixed by addressing only one side.

Great article Beth. I like the distinction you made between rationing and budgeting. Rationing usually means government rationing which means by force. It means citizens have no choice but to accept the allotment decreed by government. They have no place else to go. It is the initiation of indirect force by some against others. It is politically and morally wrong.

I would add to a good article, focus on facts, and reinforce Jack Carlon’s point.

Collective action is valuable when the cost is beyond an individual’s capability. Examples: No single entity could have funded the interstate highway system, but our collective contribution improved all of our lives. Everyone may need one garden hose, but when your neighbor’s house is on fire, you lend him yours.

However, each person must pay for their own driveway, and no one should expect that the neighbors will provide them a new hose, for a lifetime.

FACTS: About 2/3 ths of an American’s life time medical expenses occur in the last few months of life.
At enormous costs, this schedule can be extended a few months.
Medical technology is extremely complex, hideously expensive and changes by the hour.
But most important, everyone must die, a hard fact of life.

Thus decisions about death must be confronted by some extremely well educated person or terrible situations will happen. From a cost viewpoint, death panels (a bad political phrasing) must exist. Our only choices are to authorize an entity like the Post Office, or someone like jack carlson to make the decisions, in a private room, two doors from sick grandma? It is immoral to bankrupt her grand kids to keep her alive for a few more weeks, simply because it is possible to dump her health costs on everyone else. Jack knows her, and knows that a team of peers will review his big decisions. He should not function considering a swarm of lawyers continually seeks his life’s savings. It forces him to up the costs on everybody, by ordering useless efforts, as a defense.

The inevitable result of socialized medicine is mendacity in the labs, an explosion of bureaucrats in the sick rooms, and lots of needless agony, and fury.

Jack’s job is to struggle to heal, or overtly let grandma die in peace and comfort.

The solution is simple; rescind the federal legal requirement that hospitals must provide health care to everyone that shows up in ER regardless of their ability to pay or their absence of insurance. Now that’s what I call rationing up front, triage at the counter! (Wallet triage already happens during the ambulance ride!) If you can’t pay to be cured or treated, because you don’t want participate in interstate commerce, the hospital will provide the cheap morphine and the sodium pentathol in the five minute hospice wing of ER, and a ride to the morgue for a paupers burial or cremation. Take your pick. I’m sure the insurance industry, designer drug companies, gravediggers, and doctor driven health care markets and teaching hospitals would rapidly experience some realistic health care price discovery. Maybe they could use all the bodies for medical dissection classes to train more doctors to get the prices down, or for organ donations, and in that way offset the costs for the morphine, pentathol, and gravediggers? What do you think?

I think that most hospitals in the US are non-profit and that the American people are compassionate and generous. We want everyone to have the health care they need. But we must find a way to provide it that does not involve coercion. Government provision of health care has crowded out private charity. We need to get government (and coercion) out of health care and let our generosity take over once again.

Ultimately the solution is a completely free market in health care. The government must be banned from involvement in medicine at any level. End the Dept. of HHS and FDA, along with Medicare and Medicaid. Stop influencing insurance choices through tax policy and “health care bills”. End all government oversight of doctors, hospitals, and professional licensing standards. All government involvement has done is destroy the field of medicine as it has destroyed the housing market and every other industry it touches. If it continues we’ll be living the world of Atlas Shrugged. Oh, wait — we are.

This article confuses the entire issue. Rationing is a market phenomena. When price is allowed to moved freely to clear the market, total quantity demanded equals total quantity supplied. When governments artificially set price below the equilibrium level, then quantity demanded exceeds quantity supplied: people want to buy more of the product than sellers are willing to sell at the set price. This requires some form of non-market decision to decide who gets the product, in this case medical care. This forces buyers to compete for medical care not by working and producing products that people want, and using the income earned to buy medical care, but rather forces buyers oompete by using there scarce time unproductively, waiting in line for the underpriced medical care. This diversion of time from producing to waiting in line is the social cost of rationing. That cost includes the suffering and deaths cause by the arbitrary priorities set by bureaucrats without knowledge of individual cases. Berwick is a great proponent of the wealth-destructive misallocation of resources and the arbitrary allocation of medical services. Of course, politicians and other important government workers, such as Dr. Berwick, will be exempted from waiting in line for medical treatment, as will other favord classes.

I would call what you describe as shortages due to price controls, with all of the subsequent misallocations you list–but I wouldn’t call any thing the market does “rationing.” Resource allocation decisions are not made by the market or by prices. They are made by people. True—when the prices are set artificially rather than according to supply and demand, the prices no longer send accurate signals and it be comes impossible to know or act on the true scarcity of of anything.

And as for Berwick: He truly believes it is possible to scientifically and “rationally” make all those decisions for us through central command and control–and because of “social justice” demands for “equity,” that it’s the right thing to do. I don’t think we will change his mind, but more people need to understand why he is wrong on both accounts.

The market doesn’t ration – agreed. But doesn’t rationing imply a limited supply of something ? I think you have it correct that a shortage is created due to price controls (and a host of other rules and regulations) — all of which are inherent in the direction we are being taken.

Your lifeboat example is spot on when considering a non-competitive healthcare service market. There will only be so much food and water to go around — just as there will be only so many primary care doctors, less medical advancements and declining pharmaceutical breakthroughs. Primarily because of the system we are being forced to accept.

With proper incentives (i.e., fewer imposed central planning controls that negatively distort market behavior + a move away from single payor and third party payment) the prevalence and magnitude of shortages would be mitigated to a large extent.

As for Dr Berwick, he is an idea implementer and therefore more directly culpable than other theorists who may agree with him. Sure there would be clones were it not him in the post. But I’m not sure I get the logic of limiting attacks to the ideas and not the man. All other things being equal, how would that work in the case of Castro’s implementation of healthcare delivery ?

Maybe being tautological means a small mind for petty details, but it seems to me if the market is not rationing by price, then you don’t have a free market allocating the consequences of decision making by the actors. Even cheating, printing more money to devalue the medium of exchange, money, to maintain aggregate demand or offset aggregate debt loads is manipulating the market by price. So, the American pet, Mr. Dog, can get his spleen removed for twelve hundred bucks, because there is no health care lobby in Washington ostensibly looking out for Mr. Dog’s interests and the vet’s profitable business model; now just you try getting your spleen removed for twelve hundred bucks at Stanford.

I guess I see attacking the man as a distraction. We aren’t going to change things by putting someone else in Berwick’s place. It will just be a game of whack a mole. In fact, given Medicare as it is I WANT someone rationing the goods. Berwick is a tried and true central planner, but as central planners go, his knowledge of quality improvement would be an improvement over a lot of others. I’ve been reading his articles and books. He’s got some great ideas—if only he would work for some private company, he’d have a lot to offer. The problem is that he wants to be the health care czar and impose it all on us by force. The fact that he CAN impose it by force is a fault of the current the system—and that won’t change until we can get people to understand why it’s wrong.

The love for the UK’s NHS is a joke — I have an acquaintance who owns a US medical billing s/w company, and he has been flying to London several times these last few months on a contract to help the NHS figure out how to properly account for the internal costs. In their system they just don’t have any decent data to work with — they’re using his US data as a way to get started.

This is the first article I have read from Dr. Haynes, but I thank her for providing a well thought through piece that first carefully identifies the characters on the stage and then follows through on the unquestionable consequences of the free and the un-free choice mechanisms currently being proposed for America’s health care.

The choice is between those who choose to live within their means and those who choose to live at someone else’s expense by stealing from those whose energy and self-discipline has provided them with some resources left to steal. And as Dr. Haynes points out this is also the difference between freedom of medical choice versus the right to stand in line to suck on the public cash-cow’s teat, hopefully before it goes dry.

Thank you again Dr. Haynes, I think Frederic Bastiat is cheering you on from his special place in heaven.

I agree with Dr. Haynes premise that Medicare/Medicaid are collectivized medicine and are incompatible with freedom.

It is freedom, in the marketplace as well as politically, that will give America the medical system it once had: excellent care at a reasonable cost. It exists today in all the fields of medicine which are not under government control: dentistry, cosmetic surgery, penile implants, hair transplants, radial keratonomy, etc. Those procedures are not cheap but they are affordable, they are easy to get, they are of top quality to not so good quality, but you, the consumer, decide what you want, when, how, etc. It’s all up to you, payment plans included.

It’s immoral for the government to force us to deal with them alone for our healthcare.

Rationing does not mean that the government will not fund certain medical services. Rationing means the government impairs my right to purchase the medical services I want from a willing provider at a mutually agreeable price. Rationing of this sort has existed on a small scale in Medicare for well over a decade.